Peripheral Vascular Diseases Flashcards
What is a perforator vein?
they perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain
Superficial –> perforator –> deep veins
What is the hydrostatic indifferent point?
The hydrostatic indifference point (HIP; where venous pressure is unaffected by posture) is located at the level of the diaphragm.
What percentage of acute thrombosis are due to cancer?
40%
What is Virchow’s Triad?
Virchow’s triad or the triad of Virchow describes the three broad categories of factors that are thought to contribute to thrombosis:
- Hypercoagulability
- Hemodynamic changes (stasis, turbulence)
- Endothelial injury/dysfunction.
What may cause stasis (ie. blood is not flowing or circulating as optimally as it could to all parts of the body)?
Venous stasis, mitral stenosis, prolonged immobility (such as car or plane ride or bed bound), varicose veins
What may cause hypercoagulability?
Antithrombin III, protein C and S, Leiden V Factor
Nephrotic syndrome, Trauma and burns, obesity, race, age
Disseminated cancer, hormonal contraceptives, smoking
What is Phlegmasia Cerulea Dolens?
acute DVT characterized by marked swelling of the extremities with pain and cyanosis, which in turn may lead to arterial ischemia and ultimately cause gangrene with high amputation and mortality rates.
What do treatments target for acute thrombosis?
prevention centers on anticoagulation and preventing platelet adherence to the endothelium
What are some Pharmaco-mechanical thrombolysis?
Power pulse; isolated segment thrombolysis
What can duplex scanning identify?
Duplex scanning will identify areas of obstruction and can look at reflux that would explain incompetence
What is Superficial Phlebitis?
The non-dangerous “blood clot” to the surperficial veins only (not the deep).
Leg gets red, hot, and painful in a localized area.
An inflammatory process
What is Chronic Venous Insufficiency?
Deep venous valves are not working
What is Post Thrombotic Syndrome?
CVI that develops after DVT
What may cause varicose veins?
- incompetent perforators
- incompetent superficial valves
What is the Trendelenberg Test?
The Trendelenburg Test or Brodie-Trendelenburg test is a test which can be carried out as part of a physical examination to determine the competency of the valves in the superficial and deep veins of the legs in patients with varicose veins.
What is the positive finding?
What may contribute to chronic swelling?
- Arterial Problems:
Rest pain, post op (reperfusion injury), aneurysms - Venous Problems:
Chronic occlusion
Chronic Venous Insufficiency - Lymphatic Problems:
Lymphedema- Primary and Secondary - Musculoskeletal: Baker’s Cyst, tumors
- Abnormal Growth: Ateriovenous malformations, tumors,
How to assess swelling?
- pitting vs. non-pitting (does socks cut in or leave a mark)
- measure circumference
T or F: the swelling caused by lymphedema is pitting
F: non-pitting
What are some functions of the lymphatic system?
- Removes excess interstitial fluid and protein from the tissues
- Removes fats and fatty acids from the gut
- Transports white blood cells and antibacterial defense system back and forth from tissues, lymph nodes and marrow.
Is swelling hard to treat resulting from lymphedema?
Yes, and does not disappear easily
What is primary lymphedema?
Congenital lack of sufficient number of lymphatics that manifests itself at different ages
True or False: 1o lymphedema occurs in men more and in the right leg
False: women; left leg
What are the different classes of 1o lymphedema?
Lymphedema cogenta (baby, child) Lymphedema praecox (early 20’s) Lymphedema tarda (elderly)
What is the most common cause of 2o lymphedema?
due to an infestation of the lymph nodes by the parasite Filaria bancrofti
(cancer surgery and/or radiation more so common in NA)
True or False: in CVI there elevated ambulatory venous pressure (ie. hypertension)?
True
For venous issues what would you look dermatologically?
Irregular, often deep ulcer Draining if leg edematous Pigmentation Subcutaneous stiffness (lipodermatosclerosis) Old or new ulceration Edema: pitting or non pitting Varicosities, spider veins
True of False: majority of those with CVI had a previous DVT
False
What happens in persistent calf pump failure?
Dilation and elongation of venules and capillaries
–> The main factor contributing to the development and progression of varicose veins is sustained venous hypertension that increases the diameter of the superficial veins resulting in further valve incompetence.
Contraction of calf muscle opens vein valves and promotes
What is usual pathogenesis of CVI?
- Calf Pump Failure
- Capillary and Venular Elongation and Dilatation
- Increased production of tissue fluid with raised fibrinogen concentration and raised inhibitors of fibrinolysis
- Tissue Anoxia and Malnutrition
- Lipodermatosclerosis
- 5 Trauma
- Ulcer
What risk is increased with elevated ambulatory venous pressures?
ulcers
What are the benefits of graduated compression therapy?
- increased venous return
- increased removal of fibrin
- decreased edema
- decreased distention of superficial veins
What is the primary treatment of CVI?
compression
What is sclerotherapy?
Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink.
What are some treatment options for saphenofemoral insufficiency?
- ligation (tieing)
- stripping (removing)
- endovenous ablation (damaging with heat)
